News

HIV Spreading in New York City at About Three Times the National Rate, Study Finds

HIV is spreading in New York City at about three times the national rate, with an incidence of 72 new HIV infections per 100,000 people, compared with 23 new infections per 100,000 people nationwide, according to a study released Wednesday by the New York City Department of Health and Mental Hygiene, the New York Times reports (Chan, New York Times, 8/28).

The study's findings are based on a new HIV testing method developed by CDC that can determine when an HIV infection occurred. Previous data did not distinguish recent infections from those that occurred years earlier, according to the health department. About 100,000 New York residents are living with HIV, health officials said (Honan, Reuters, 8/27). According to the study, 4,762 New York residents contracted HIV in 2006 (New York Times, 8/28). Health officials attributed the higher rate of new HIV infections in the city to large populations of blacks, men who have sex with men and other high-risk groups (AP/Google.com, 8/27). According to the health department, it is unclear whether the number of new infections that occurred in the city in 2006 had increased or decreased over previous years because the testing method is new.

According to the study, men accounted for 76% of new HIV infections while women accounted for 25%. Blacks accounted for 46% of new infections, Hispanics for 32% and whites for 21%. Whites living in the city contracted HIV at four times the national rate, Hispanics at three times the national rate, and blacks in the city contracted the virus at almost twice the national rate. The study found that 4% of new infections were among people younger than age 20, while people ages 20 to 29 accounted for 24% of new infections. People ages 30 to 39 and those ages 40 to 49 each accounted for 29% of new infections, while people older than age 50 accounted for 15%. People younger than age 30 accounted for 28% of new infections in New York City, compared with 41% nationwide.

The primary mode of HIV transmission was sex between men, which accounted for 50% of new infections. High-risk heterosexual sex accounted for 22% of new infections, and injection drug use accounted for 8%. The mode of transmission was unknown in 18% of new cases, the study found (New York Times, 8/28).

In addition, the study found that blacks living in the city contracted HIV at three times the rate of whites and that blacks accounted for almost half of new infections (Reuters, 8/27). Of new HIV infections among MSM younger than age 30, 77% occurred in black and Hispanic men. Black and Hispanic MSM ages 30 to 50 also accounted for 59% of new infections among MSM in that age group (New York Times, 8/28).

Assistant Health Commissioner Monica Sweeney said the study's findings reinforce the need to continue promoting HIV testing and prevention throughout the city (AP/Google.com, 8/27). The department in a statement added that "even a rough gauge of HIV incidence is a valuable tool for understanding -- and combating -- the spread of HIV." The department said that by using the same testing method in future years, "researchers may be able to discern increases and decreases [in HIV incidence] over time and target prevention efforts accordingly" (New York Times, 8/28). read more

Uganda Facing Challenges With Its Efforts To Prevent Mother-to-Child HIV Transmission

Mother-to-child HIV transmission rates remain high in Uganda, despite services made available by the government to prevent MTCT, IRIN/PlusNews reports. Government figures estimate 20,000 children contract the virus annually, accounting for 42% of all new cases in the country, according to IRIN/PlusNews. "The large and growing unmet need for pediatric HIV/AIDS (services) demonstrates that failure of our PMTCT programs to avert parent-to-child-transmission of HIV," Keith McKenzie, country representative for UNICEF, said. Of the approximately 100,000 people with antiretroviral drug access in Uganda, 10,000 are children, according to the Ministry of Health. An additional 40,000 children are believed to be in need of treatment access, and slightly more than half of the country's 310 antiretroviral clinics provide pediatric drugs. "If we prevent HIV infection in children, then we do not need to take care of them when they are infected," Phillipa Musoke, chair of the health department's pediatric committee, said.

According to IRIN/PlusNews, most pregnant women in Uganda have access to PMTCT services but 60% to 70% of them deliver at home, making it "impossible" to administer antiretrovirals that can prevent MTCT, according to IRIN/PlusNews. In addition, awareness of available services and infant feeding options still is low, according to IRIN/PlusNews. Deogratius Mugisa of the health ministry in central Uganda's Kayunga district said, "Cultural beliefs, social stigma, ignorance and economic status influenced the mother's attitudes and preference for the different (feeding) alternatives."

Dennis Tindyebwa, technical director of the Elizabeth Glaser Pediatric AIDS Foundation, said that 98% of pregnant women in Uganda agreed to HIV testing and counseling but that only 67% returned for their results. Of those who tested HIV-positive, very few came to health centers to give birth, Tindyebwa said, adding that distances to health centers, a lack of infrastructure, and inadequate services and personnel contribute to the low return rate. He also said that male involvement in PMTCT is low and that men "deny their spouses the opportunity to participate in the program." Head of the Uganda AIDS Commission David Apuuli Kihumuro said that fewer pediatric HIV/AIDS cases would occur if rates of the disease among adults were controlled, adding, "We have a moral obligation to ensure that our children and grandchildren are born and remain free from HIV/AIDS" (IRIN/PlusNews, 8/26). read more

HAART Might Increase Risk of Asthma in Young Children, Study Says

Highly active antiretroviral therapy might increase the risk of asthma among children because of the therapy's effect on the immune system and CD4+ T cell levels, according to a study recently published in the Journal of Allergy and Clinical Immunology, Reuters reports. According to Reuters, in asthma, an excess of inflammatory and immune cells are produced in the lungs. Therefore, any condition or therapy that bolsters these cells, including HAART, could have an "unwanted effect," Reuters reports.

For the study, William Shearer of Texas Children's Hospital and colleagues examined the incidence and prevalence of asthma in children born to HIV-positive women. The study included 193 children living with HIV, 113 of whom were treated with HAART and 80 of whom never had received HAART. The study also included 2,471 children who were HIV-negative. The researchers found 33.5% asthma medication use among the HAART-treated children of an average age of 13.5, compared with 11.5% among the HIV-positive children who were not treated with HAART. Asthma medication use among HAART-treated children was slightly higher than among HIV-negative children, suggesting that untreated HIV might protect against asthma, according to Reuters. Additional analysis found that it was an increase in T cell levels from HAART that increased the risk of asthma, Reuters reports.

Shearer said that because studies performed before HAART's introduction in the mid-1990s did not detect the problem, "investigators have assumed that asthma is not a complication of pediatric HIV infection." Before HAART was available, T cells levels often decreased among HIV-positive people, preventing an asthmatic reaction. "It was not until the era of HAART, which restored the (T cell) levels, that an increased incidence of asthma was noted," Shearer said. He added that until further research is conducted to verify the findings, physicians should be aware that HAART could increase the risk of asthma among children. In addition, physicians need to alert parents to the issue and provide children with asthma treatment if it occurs, Shearer said (Gale, Reuters, 8/26).

An abstract of the study is available online. read more

NEJM Publishes Perspective Pieces About HIV/AIDS Vaccine Research, XVII International AIDS Conference

The New England Journal of Medicine on Thursday published two perspective pieces about HIV/AIDS vaccine research and the XVII International AIDS Conference earlier this month in Mexico City. Summaries appear below.

• Margaret Johnston and Anthony Fauci: Researchers remain "cautiously optimistic" that increased understanding of HIV will lead to "creative ideas about how to design an effective vaccine," Johnston, director of the Vaccine Research Program in the Division of AIDS at NIH's National Institute of Allergy and Infectious Diseases, and Fauci, director of NIAID, write. According to Johnston and Fauci, vaccines have been "among the most effective public health interventions," but an HIV vaccine has been "elusive and the quest disappointing and frustrating." They add that the "extraordinary mutability and resulting genetic diversity of HIV, which is substantially more complex than that of other human viruses, also present a formidable obstacle to immune control." Researchers "may not be able to develop an HIV vaccine that is highly effective in the classic sense of successful viral vaccines," the authors write, adding, "If we do, it will be in the face of enormous scientific challenges." To address such challenges, researchers "must turn to fundamental research to a degree that has not been required in the development of vaccines for other viral diseases," the authors write (Johnston/Fauci, NEJM, 8/28).
  
  
• Robert Steinbrook: The XVII International AIDS Conference earlier this month "reflected the fact that the pandemic continues to rage" in both developing and developed countries, such as the United States, "where it is often overlooked," Steinbrook, national correspondent for NEJM, writes in a perspective piece. Steinbrook writes that the message from the conference was that societies and individuals should "implement effective and multifaceted treatment and prevention programs, advance human rights and invest in AIDS health care systems." Steinbrook notes that the incidence of HIV/AIDS infection in the U.S. is "worse than was previously known, particularly among blacks and men who have sex with men" and that at the conference, "black leaders called for the United States to develop a national AIDS strategy and a 'domestic PEPFAR' program." He adds that the "challenge is to sustain and accelerate" the progress shown at the conference before the July 2010 XVIII International AIDS Conference in Vienna (Steinbrook, NEJM, 8/28).

Kaisernetwork.org was the official webcaster of the XVII International AIDS Conference in Mexico City. read more

Marginalized Populations Should Be Focus of HIV Prevention Efforts, Opinion Piece Says

Although the U.S. has "relatively abundant resources available to those living with HIV," socioeconomic gaps continue to lead to higher rates of the virus among marginalized groups in the country, Christine Jolly, president of AIDS Care Service, writes in a Winston-Salem Journal opinion piece. Jolly for the past eight years has worked for an HIV/AIDS service organization and writes that she has seen her clients "struggling daily to live simultaneously with HIV and poverty."

Following a trip earlier this month to the XVII International AIDS Conference in Mexico City, Jolly writes that the devastating toll of HIV worldwide has forced "even the most extremely conservative countries" to take "bold steps to" curb the spread of the disease. For example, Jolly writes that Iran has embraced needle-exchange programs and condom distribution to curb the spread of HIV/AIDS. Nevertheless, Jolly writes that HIV-positive people across the globe still are waging battles against discriminatory government policies, including the criminalization of homosexuality.

According to Jolly, a "common thread" throughout the conference was the acknowledgement that HIV prevalence rates are higher among marginalized populations in all countries, whether it be homosexuals, commercial sex workers, ethnic or religious minorities, and women. "To understand why marginalized populations are at higher risk of infection, you have to recognize that these groups often do not have equal access to housing, education, health care, clean drinking water or nutrition," Jolly writes, adding, "Marginalized groups also face discrimination and have less control of funding streams for health and social welfare purposes."

Although many citizens in the U.S. "enjoy rights and a quality of life much higher than do people in other nations," the fact that the country's "legal system acknowledges constitutional and civil rights, but not human rights," means there is a "void when it comes to advocating for the right to quality health care for everyone," Jolly writes, adding, "Without equal access to quality health care, the epidemic will only continue to increase in much of the world."

Although "some societies are busy playing the blame game to avoid taking on their fair share of the systematic responsibility for infections, the medical community, AIDS-service organizations and human-service agencies around the world are in the trenches trying to save lives," according to Jolly. "We will never have enough resources to defeat this epidemic if we don't have the support of our communities. Probably the single largest barrier to gaining that support is the belief that 'AIDS is not my problem,'" Jolly adds (Jolly, Winston-Salem Journal, 8/26).

Kaisernetwork.org was the official webcaster of the XVII International AIDS Conference in Mexico City. read more

JAMA Publishes Article About CDC's HIV Testing Recommendations

• "Opt-Out Testing for Human Immunodeficiency Virus in the United States," Journal of the American Medical Association: The study examines CDC's 2006 recommendations for HIV testing in the U.S. that call for routine testing with an "opt-out" strategy. According to the study, the recommendations have affected state laws with some states mandating signed consent and counseling, while other states have changed legislation to reduce barriers to testing. In addition, 35 national professional groups have endorsed the recommendations, and "multiple demonstration projects have shown feasibility." Although metrics to evaluate the health outcomes of CDC's recommendations for HIV testing have been defined, the "data necessary to determine the effect on early entry into care, the actual reduction in disease incidence and the unanticipated consequences are not yet available," the study says (Bartlett et al., JAMA, 8/27).

read more

Coalition of More Than 30 Groups Calls on Presidential Candidates To Develop National HIV/AIDS Strategy

A coalition of more than 30 HIV/AIDS advocacy groups representing minority communities in the U.S. has called on presidential candidates Sens. John McCain (R-Ariz.) and Barack Obama (D-Ill.) to develop a comprehensive national strategy to fight HIV/AIDS, VOA News reports.

Ravinia Hayes-Cozier, director of government relations and public policy for the National Minority AIDS Council, said it is important for the next U.S. president to address HIV/AIDS in the country because "there has been silence on the domestic side about HIV/AIDS." She added that is "important" that people living in the U.S. "still see [HIV/AIDS] as an epidemic that is affecting people in this country, particularly minorities," and that the number of minorities living with HIV/AIDS in the U.S. "continue[s] to go up." Minorities account for about 65% of the estimated 56,000 new HIV infections annually in the U.S., according to VOA News.

The U.S. is "one of the very few countries" that does not have a national HIV/AIDS strategy, Hayes-Cozier said, adding that the U.S. is "at a point where we've had a great deal of experience with HIV/AIDS." She added that there are "some things that we know work well. There are some things we need to modify and change, and there are some things we just shouldn't be a part of."

According to Hayes-Cozier, a national strategy should include several elements aimed at fighting HIV/AIDS, starting with HIV prevention. The strategy's prevention component would "give consistent messages across the country that everyone supports," she said, adding that the plan would "provide a way of ongoing communication around HIV/AIDS" through education, health care and media. In addition, the plan would ensure "unified" HIV counseling and testing that provides "clear outcomes and expectations" that are not "just based on individual communities or states or cities," Hayes-Cozier said.

The treatment component of the plan would outline "strong protocols in how we implement care and treatment for those who are impacted by HIV/AIDS," according to Hayes-Cozier. The treatment component also would allow the community to look at HIV/AIDS from "a chronic disease perspective," develop "clear [treatment] guidelines" and increase efforts to reduce the spread of HIV/AIDS in communities most affected by the disease, according to Hayes-Cozier (DeCapua, VOA News, 8/26).

Event Recognizes Congressional Members for HIV/AIDS Work
In related news, actor Danny Glover on Monday ahead of the Democratic National Convention in Denver recognized 26 members of Congress for their efforts to fight HIV/AIDS at a luncheon sponsored by the Global AIDS Alliance Fund and the AIDS Action Council, Roll Call reports.

Glover, who serves as chair of the TransAfrica Forum, at the luncheon said the "theme of this week is change," adding, "Let the change include a world without AIDS." He added, "The AIDS epidemic isn't about some other time [or] some other people. ... it's about my brother and your sister," noting that his brother has been living with HIV since the 1990s. Sen. Barbara Boxer (D-Calif.), who was honored at the luncheon, called for increased government funding to fight HIV/AIDS that does not include abstinence spending requirements. Boxer added that Democrats need 60 Senate seats to pass such legislation.

Democratic Reps. Barbara Lee (Calif.), Betty McCollum (Minn.), Donald Payne (N.J.) and Maxine Waters (Calif.), as well as Del. Donna Christian-Christensen (D-Virgin Islands), also attended the event. Paul Zeitz, executive director of the GAAF who organized the event, said the group works with both Democrats and Republicans and plans to attend the Republican National Convention next week in St. Paul, Minn. (Palmer/Ackley, Roll Call, 8/26).

A kaisernetwork webcast of the event is available online. read more

Stamford, Conn., Officials Concerned About HIV/AIDS Among Hispanics

HIV/AIDS advocates in Stamford, Conn., are expressing concern about HIV/AIDS cases among Hispanics and how to effectively target outreach efforts toward the community, the Stamford Advocate reports.

As of June, 118 Hispanics in Stamford were living with HIV/AIDS, according to the Stamford Health Department. Hispanics make up 22.3% of all current HIV/AIDS cases in the city and 19.7% of the population, according to estimates from the U.S. Census Bureau. In nearby Norwalk, Conn., Hispanics represent 18.6% of people living with HIV/AIDS and 24.3% of the population. Nationwide, Hispanics make up 18.9% of reported AIDS cases and 15% of the population, according to the Kaiser Family Foundation.

Debra Katz, director of Stamford's HIV prevention program, said that the figures are of concern because HIV/AIDS cases among Hispanics outpace their proportion of the population. Dennis Torres of Stamford CARES, a city agency that provides housing, financial and medical assistance to those living with HIV/AIDS, said, "I think nationally, the message hasn't reached this community."

Public health officials say that cultural beliefs, lack of health insurance and concerns about legal status are some of the barriers that prevent effective HIV/AIDS outreach programs to the Hispanic community, the Advocate reports. In addition, Hispanics' religious values and cultural taboos about discussing HIV/AIDS and sex have an effect on outreach, according to city health officials. Cedric Reid, a city HIV prevention worker, said Hispanic women are the most difficult to reach with sexual education outreach efforts because they are very modest.

Stamford health officials have made efforts to reach out to the Hispanic community by employing bilingual staff in HIV/AIDS prevention programs and conducting outreach efforts at churches and day laborer sites, Torres said. Torres added, "We help people if they have no food, if their lights are going to be shut off, all of the things that would keep people from getting medication," adding, "We remove all those barriers, because treatment is prevention" (Perez, Stamford Advocate, 8/24). read more

Increasing Number of HIV Cases Recorded in Philippines, Health Secretary Says

The number of HIV/AIDS cases recorded in the Philippines is increasing, Health Secretary Francisco Duque said on Tuesday, adding that the prevalence of the disease in the country remains low, AFP/Yahoo! News reports. Duque said that even though the Philippines is a low-prevalence country, it "should not be a reason to be complacent." An average of 29 HIV cases were reported monthly in 2007 and 2008, Duque said, adding that an average of 20 cases monthly were recorded in previous years, according to AFP/Yahoo! News.

According to AFP/Yahoo! News, a health department report on HIV/AIDS in the Philippines found that 48% of female commercial sex workers, 27% of injection drug users, and 49% of men who have sex with men and people with multiple sex partners reported using a condom. The report called for a focus on "prevention activities geared towards vulnerable populations," as well as a "scaled up response for making available affordable treatments and control." The report also states that since 1984, a total of 3,305 HIV cases and 310 AIDS-related deaths have been reported in the Philippines (AFP/Yahoo! News, 8/26). read more

Malawi Reduces AIDS-Related Deaths With Increased Access to No-Cost Antiretrovirals

Increased access to no-cost antiretroviral drugs has contributed to a 75% decrease in AIDS-related deaths in Malawi in the last four years, a senior government official said Monday, Reuters reports. According to Reuters, HIV/AIDS has been linked to 59% of deaths among people between ages 15 and 59 in the country of 13 million. However, Malawi has made progress since 2004, when it started offering no-cost antiretrovirals to thousands of HIV-positive people, Reuters reports.

Mary Shawa, Malawi's principle secretary for HIV/AIDS, said, "I am happy that AIDS-related deaths have decreased by over 75% over the last four years in comparison with AIDS-related deaths we had in 2003 to 2004 because of increased free treatment."

According to Reuters, there have been about 800,000 AIDS-related deaths recorded in Malawi since the first case of the disease was reported in 1985. As of March, the government had provided 159,111 people with access to no-cost antiretrovirals, of whom 106,547 still are alive. Shawa said, "This represents a 67% survival rate. But we still need to do more, because those who did not make it may have died because they started the treatment late or did not have access to proper nutrition" (Banda, Reuters, 8/25). read more

New Orleans Ministers' HIV Testing Campaign Helps Address Stigma in Black Community, Editorial Says

The seven New Orleans black ministers who participated in the Clergy Community HIV Testing Day earlier this week are "helping to remove the fear and stigma that prevents people from learning their HIV status," a New Orleans Times-Picayune editorial says. According to the editorial, the ministers broke "what they described as the black church's silence on HIV/AIDS" when they publically took HIV tests in front of their congregations and "urg[ed] congregants to do likewise." Sixty-three percent of the newly diagnosed HIV cases in New Orleans last year were among blacks, the editorial says. Early prevention is a "critical message, especially for" blacks, the editorial says, concluding that the ministers' "actions spoke volumes to a vulnerable population" (New Orleans Times-Picayune, 8/27). read more

Human Rights Should Be Focus of Efforts To Fight HIV/AIDS Worldwide, Editorial Says

The U.S. should shift its policy on fighting HIV/AIDS to a "fight for basic human equality, providing a basis for more realistic outreach," a Daytona Beach News Journal editorial says. According to the editorial, HIV/AIDS is "reclaiming a foothold" around the world among younger populations "who don't want to admit they may be vulnerable" or think of the virus "as something treatable." It adds that nearly half of new HIV cases globally occur among people between ages 15 and 24. The "problem is immeasurably more difficult" in countries where many women "lack the power to say no to sex" and few men openly admit relationships with other men, the editorial says, adding that U.S. "pressure on human rights issues, such as the criminalization of homosexuality, could help bring those at risk out of the shadows."

Abstinence programs funded by the U.S. should be replaced by "fact-based, realistic prevention that emerging countries need," the editorial says, adding that "without political will and education, many will never know how to stop AIDS effectively." A "shift in U.S. policy would also acknowledge that the fight against HIV is also a fight for basic human equality, providing a basis for more realistic outreach," the editorial adds. The "best defense against disease remains knowledge" and "fundamental human rights," the editorial says, concluding that any "prevention program that doesn't acknowledge that fact will have faltered before it begins" (Daytona Beach News Journal, 8/25). read more

HIV-Positive Renters in New York City Leaving Homes Because of Foreclosures, New York Times Reports

At least 50 HIV-positive renters in New York City have notified city housing organizations in the past few months that they had to leave their homes or have been evicted because of foreclosures and that they are having difficulty finding new homes, the New York Times reports.

According to the Times, although the exact number of families affected by the nationwide housing crisis is unclear, officials have said HIV-positive renters are in a "particular squeeze." Foreclosure rates in New York City have doubled between 2004 and 2007, according to a study by the Furman Center for Real Estate and Urban Policy at New York University. HIV-positive people face special difficulties when their rental homes go into foreclosure because of a lack of public funding to assist them and ineffective laws aimed at preventing landlords from discriminating against HIV-positive people, the Times reports. In addition, issues faced by HIV-positive tenants "begin long before the eviction date, when landlords with nothing else to lose stop paying the utilities," according to the Times.

The city's HIV/AIDS Services Administration provides rental assistance to HIV-positive people, and the City Council in March made it illegal for landlords to discriminate against rental applicants who receive federal, state and local housing assistance; however, the law applies only to buildings with six or more units and does not penalize people who violate it. In addition, although HASA provides assistance, people are expected to contribute 30% of their incomes to their housing costs but cannot be left with less than $330 monthly.

Sean Barry, co-director of the New York City AIDS Housing Network, said that HASA "pays 20% less" than the federal Section 8 housing program, adding, "If a landlord has multiple clients applying with Section 8 or HASA, they know they can play around with the regulations and get more money from Section 8." The city provides emergency housing to people living with HIV/AIDS who are evicted from their homes; however, the housing is intended to be temporary (Dembosky, New York Times, 8/26). read more

City Funding Reaches Needle-Exchange Programs in Washington, D.C.

Funding for needle-exchange programs in Washington, D.C., is beginning to reach groups that run the programs eight months after Congress lifted a ban of city funding for needle-exchange programs, but it is unclear how effective the increased funding will be at reducing the spread of HIV in the district, the AP/Washington Times reports (Westley, AP/Washington Times, 8/24). City officials in January announced that the district would invest in needle-exchange programs to help prevent the spread of HIV among injection drug users in the city. The announcement came after President Bush signed a fiscal year 2008 omnibus spending bill (HR 2764) that effectively lifted a ban on city funding for needle-exchange programs in the district. Since 1999, the district had been the only U.S. city barred by federal law from using local funds for needle-exchange programs (Kaiser Daily HIV/AIDS Report, 4/25).

According to the AP/Times, the district is allocating $700,000 annually for needle-exchange programs. The district has allocated $300,000 over three years, the largest share of funding, to the needle-exchange program PreventionWorks!. Needle-exchange programs aimed at commercial sex workers and homeless people also have received district funding, the AP/Times reports. According to a report released last year by the district's HIV/AIDS Administration, injection drug use is the second most common mode of HIV transmission in the city, following unprotected sex. There are about 10,000 IDUs living in the district, the AP/Times reports. The White House Office of National Drug Control Policy has criticized needle-exchange programs, arguing that such programs increase spread of HIV because they do not curb risky behaviors associated with needle-sharing.

According to the AP/Times, the district has the highest HIV prevalence in the country, with one in 20 residents estimated to be living with HIV. Walter Smith, director of the D.C. Appleseed Center for Law and Justice, said, "There are multiple factors that have produced [the district's] high HIV/AIDS rate, and it will take multiple factors to bring it down." He added that there is "no silver bullet" to reduce the spread of the disease (AP/Washington Times, 8/24). read more

New York Health Department To Decide Soon Whether Medicaid Beneficiaries With HIV/AIDS Should Be Moved Into Managed Care Plans

The New York State Department of Health in the next few weeks is expected to issue a final decision on whether to switch Medicaid beneficiaries with HIV/AIDS from fee-for-service plans to managed care plans, the AP/Long Island Newsday reports (AP/Long Island Newsday, 8/24). Since the late 1990s, the state's 65,000 people living with HIV/AIDS who are enrolled in New York's Medicaid program have been exempt from a statewide enrollment drive to place beneficiaries into managed care plans. About 10,000 HIV-positive beneficiaries were enrolled in Medicaid managed care plans as of late last year (Kaiser Daily HIV/AIDS Report, 12/3/07).

According to the AP/Newsday, some HIV/AIDS advocates have said that the change would result in lower quality care and that switching plans could interrupt services for some patients. Charles King, president and CEO of Housing Works, said, "This is being done simply to save the state money, and that's not a good argument for managed care."

Claudia Hutton, a spokesperson for the health department, said, "This is not about saving money. This is about using the money we spend to purchase better quality coverage for Medicaid patients." She added, "We used to have 6,500 doctors in Medicaid managed care ready to serve the needs of HIV/AIDS patients. Now we have 13,000. Most Medicaid fee-for-service providers serving AIDS patients are joining managed care networks to continue the doctor-patient relationship."

According to the AP/Newsday, the state health department said studies it has conducted indicate that all patients, including people living with HIV/AIDS, are more likely to thrive under managed care plans. In addition, officials said that Medicaid Special Needs Plans are available and can cater to patients' individual needs. Those enrolled in such plans reported fewer interruptions in relationships with care providers than those enrolled in fee-for-service plans and had fewer emergency department visits, fewer pneumonia cases and were more likely to obtain antiretrovirals.

A separate, preliminary study found that those with HIV/AIDS who are enrolled in regular Medicaid managed care plans in New York state are more than twice as likely as those in fee-for-service plans to be screened for breast cancer or cholesterol. However, those with HIV/AIDS enrolled in fee-for-service plans were more likely to have regular dental visits and have a continuous supply of antiretrovirals. Special Needs Plans "outperformed" both regular managed care plans and fee-for-service plans, according to the AP/Newsday (AP/Long Island Newsday, 8/25). read more

Daily HIV/AIDS Report